Flexible sigmoidoscopy for colorectal cancer screening: More evidence, persistent ironies
Mené en Norvège sur 98 792 personnes âgées de 50 à 64 ans (durée médiane de suivi : 10,9 ans), cet essai randomisé évalue, en fonction de deux catégories d'âge, l'intérêt de la sigmoïdoscopie flexible pour réduire l'incidence du cancer colorectal et la mortalité spécifique
In this issue of JAMA, Holme and colleagues1 report results of a large randomized trial of colorectal cancer screening in Norway in which one-time flexible sigmoidoscopy was compared with no screening. In intention-to-screen analysis—which included all people invited for screening, regardless of their follow-through—relative reductions in colorectal cancer incidence and cancer-specific mortality were 20% and 27% in the sigmoidoscopy group, respectively, compared with the no-screening control group, during an average follow-up of about 11 years. In absolute terms, colorectal cancer death was averted in 1 person per 1000; cancer-specific mortality was roughly 4 per 1000 in the control group and 3 per 1000 in the sigmoidoscopy group. Colorectal cancer mortality curves did not diverge until the ninth year, suggesting that the benefit of screening might increase with longer follow-up. Additionally, because only two-thirds of people invited for screening actually participated, the population benefit would likely be higher with greater adherence. Half the sigmoidoscopy group also received one-time immunological fecal occult blood testing (FOBT), but this addition did not improve outcomes beyond sigmoidoscopy alone.
JAMA , éditorial, 2013